OBJECTIVE: This study aimed to identify the predictors for treatment failure of medical management among admitted female patients diagnosed with pelvic inflammatory disease with tubo-ovarian abscess. METHODS: This was a retrospective nested case-control study, using chart review of all cases of pelvic inflammatory disease with tubo-ovarian abscess/complex (N = 49) admitted at the Department of Obstetrics and Gynecology, Philippine General Hospital from January 1, 2014 to December 31, 2018. RESULTS: Medical treatment failure was observed to be significantly higher (51.9%) among patients 40 years old and above as compared to patients less than 40 years old (13.6%). The risk of patients ≥40 years for failed management was 14x higher than those <40 years old (OR=14.00; 95% CI=1.06 to 185.5;p=0.04). The failed management group has significantly higher TOA size of 7.8 (7.8 ± 1.6) as compared to only 5.8 (5.8 ± 1.4) for medical treatment alone group. Correspondingly, those who failed have a significantly bigger volume of 120.4 ml (120.4 ± 84.5) as compared to only 55.2 ml (55.2 ± 40.6) for medical treatment alone group. Other predictive factors such as parity, admitting White blood cell count(WBC), C-Reactive Protein (CRP), and neutrophil-lymphocytic ratio(NLR) were all not significant. CONCLUSION: Tubo-ovarian abscess size of more than or equal to 7 cm, or a volume of more than or equal to 120 ml and advanced age of >40 were all predictive of failed response to medical treatment. Early recognition and intervention whether surgery or drainage may be beneficial to reduce morbidity and long-term sequelae of PID.
C-Reactive Protein ; Pelvic Inflammatory Disease ; Abscess ; Neutrophils ; Oophoritis ; Salpingitis ; Abdominal Abscess ; Lymphocytes

Tubo-ovarian abscess in pregnancy is extremely rare. Its occurrence increases the maternal and fetal morbidities and mortalities. The clinical presentation is variable ranging from asymptomatic abscess to diffuse peritonitis. In this report, we present a rare case of tubo-ovarian abscess complicating a pregnancy on its 6 weeks and 5 days age of gestation. The patient presented with frank peritonitis. Internal examination revealed uterine, adnexal and cervical tenderness with no masses palpated. A laparotomy was done and intra-operative findings showed an 8 x 4 cm-sized, right, ruptured tubo-ovarian abscess with purulent contamination of the whole pelvic cavity. Right salpingooophorectomy was performed and parenteral antibiotics were given. The pregnancy was eventually carried to term and the patient delivered by repeat low segment cesarean section without fetal and maternal complications.
Pregnancy ; Female ; Abscess ; Oophoritis ; Salpingitis ; Abdominal Abscess

Crohn disease has a wide spectrum of clinical presentations and rarely can present with complications such as a bowel stricture or fistula. In this case report, we describe a 17-year-old male who presented with a history of recurrent anterior abdominal wall abscesses and dysuria. He was diagnosed with Crohn disease and also found to have a fistulous communication between the terminal ileum and a patent urachus. An ileocecectomy with primary anastomosis and complete resection of the abscess cavity was performed. He is on azathioprine for maintenance therapy and currently in remission. Clinicians should have a high index of suspicion for this complication in Crohn disease patients presenting with symptoms suggestive of urachal anomalies such as suprapubic abdominal pain, dysuria, umbilical discharge, and periumbilical mass.
Abdominal Pain ; Abdominal Wall ; Abscess ; Adolescent ; Azathioprine ; Constriction, Pathologic ; Crohn Disease* ; Dysuria ; Fistula* ; Humans ; Ileum ; Inflammatory Bowel Diseases ; Intestinal Fistula ; Male ; Urachus

PURPOSE: Although laparoscopic adjustable gastric bands are considered a standard treatment for severe obesity, their use remains controversial. We evaluated rates of band explantation and the incidences of complications leading to and following band explantation. MATERIALS AND METHODS: This retrospective review was performed on patients that underwent adjustable gastric band explantation. For each of the three groups of patients that underwent explantation, we compared demographic and anthropometric data, band duration in situ, operative approach, and morbidities. RESULTS: Between January 2009 and October 2018, a total of 267 patients underwent primary laparoscopic adjustable gastric band surgery. Of these 267 patients, 99 (37.1%) underwent band explantation. Numbers (%) of patients in the slippage (SL), band erosion (BE), and intolerance (IT) groups were 13 (13.1%), 39 (39.4), and 47 (47.5%), respectively. Mean %EBMIL values at explantation in these groups were 74.6±45.5, 79.7±40.3, and 36.1±46.0, respectively (p<0.001), and mean times for maintaining bands in situ were 45.1±28.0, 39.4±24.3, and 51.2±22.7 months, respectively. Isolated band removal was performed for slippage (SLi, n=12), band erosion (BEi, n=39), and intolerance (ITi, n=31). The numbers (%) of patients in the SLi, BEi, and ITi groups that experienced a surgical complication (Clavien-Dindo class ≥1) were 0 (0.0%), 24 (61.5%), and 3 (9.7%), respectively (p<0.001). In the BEi group, four patients (4/39, 10.3%) underwent reoperation after AGB removal. CONCLUSION: During our 10 years of experience, 37.1% of adjustable gastric band had to be removed. Intra-abdominal abscess and intragastric bleeding were rare but serious complications after explantation. Potential candidates for adjustable gastric band should be informed of the high long-term risk of band explantation and its associated morbidities.
Abdominal Abscess ; Hemorrhage ; Humans ; Incidence ; Obesity, Morbid ; Reoperation ; Retrospective Studies

BACKGROUND: Incisional hernia is a common complication following visceral organ transplantation. Transplant patients are at increased risk of primary and recurrent hernias due to chronic immune suppression and large incisions. We conducted a retrospective review of patients with a history of liver or kidney transplantation who underwent hernia repair to analyze outcomes and hernia recurrence. METHODS: This is a single center, retrospective review of 19 patients who received kidney and/or liver transplantation prior to presenting with an incisional hernia from 2011 to 2017. All hernias were repaired with open component separation technique (CST) with biologic mesh underlay. RESULTS: The mean age of patients was 61.0±8.3 years old, with a mean body mass index of 28.4±4.8 kg/m², 15 males (78.9%), and four females (21.1%). There were seven kidney, 11 liver, and one combined liver and kidney transplant patients. The most common comorbidities were hypertension (16 patients, 84.2%), diabetes (9 patients, 47.4%), and tobacco use (8 patients, 42.1%). Complications occurred in six patients (31.6%) including hematoma (1/19), abscess (1/19), seroma (2/19), and hernia recurrence (3/19) at mean follow-up of 28.7±22.8 months. With the exception of two patients with incomplete follow-up, all patients healed at a median time of 27 days. CONCLUSIONS: This small, retrospective series of complex open CST in transplant patients shows acceptable rates of long-term hernia recurrence and healing. By using a multidisciplinary approach for abdominal wall reconstruction, we believe that modified open CST with biologic mesh is a safe and effective technique in the transplant population with complex abdominal hernias.
Abdominal Wall ; Abscess ; Body Mass Index ; Comorbidity ; Female ; Follow-Up Studies ; Hematoma ; Hernia ; Hernia, Abdominal ; Herniorrhaphy ; Humans ; Hypertension ; Immunosuppression ; Incisional Hernia ; Kidney Transplantation ; Kidney ; Liver Transplantation ; Liver ; Male ; Organ Transplantation ; Recurrence ; Retrospective Studies ; Seroma ; Surgical Mesh ; Tobacco Use ; Transplants

Endoscopic ultrasound (EUS)-guided transgastric drainage has been performed as a less invasive procedure for pancreatic fistulas and intra-abdominal abscesses occurring after surgery in recent years. However, there are no reports of EUS-guided transgastric drainage of intra-abdominal abscesses following gastrectomy. This case report describes 2 patients who developed an intra-abdominal abscess following gastrectomy and underwent EUS-guided transgastric drainage. Both patients underwent laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction for gastric cancer. The intra-abdominal abscesses were caused by postoperative pancreatic fistula that developed following gastrectomy. One patient underwent naso-cystic drainage and the other underwent only a needle puncture of the abscess cavity. EUS-guided drainage was performed safely and effectively, although 1 patient developed gastroduodenal anastomotic leakage related to this procedure. In summary, EUS-guided transgastric drainage is safe and technically feasible even in post-gastrectomy patients. However, it is necessary to be careful if this procedure is performed in the early period following gastrectomy.
Abdominal Abscess ; Abscess ; Anastomotic Leak ; Drainage ; Gastrectomy ; Humans ; Needles ; Pancreatic Fistula ; Punctures ; Stomach Neoplasms ; Ultrasonography

Radiofrequency ablation (RFA) is a minimally invasive local therapy for hepatocellular carcinoma (HCC). Even though RFA is considered to be a safe treatment modality, a variety of complications have been reported. Recently, we encountered a case of refractory fistula between a liver abscess and the gallbladder after RFA. A 64-year-old woman diagnosed with HCC associated with chronic hepatitis B was treated by RFA. After RFA, she experienced abdominal pain, and abdominal computed tomography (CT) revealed a liver abscess complicated by a previous treatment of HCC, she was treated with intravenous antibiotics and percutaneous abscess drainage. Follow-up abdominal CT revealed a fistula between the liver abscess and gallbladder, which was successfully treated with percutaneous transcatheter n-butyl-2-cyanoacrylate (NBCA) embolization. We herein report the rare case of a refractory fistula between a liver abscess and the gallbladder after RFA in a patient treated with NBCA embolization.
Abdominal Pain ; Abscess ; Anti-Bacterial Agents ; Carcinoma, Hepatocellular ; Catheter Ablation ; Drainage ; Enbucrilate ; Female ; Fistula ; Follow-Up Studies ; Gallbladder ; Hepatitis B, Chronic ; Humans ; Liver Abscess ; Middle Aged ; Tomography, X-Ray Computed

Cases showing complications such as esophageal injury, deep neck infection, and mediastinitis caused by accidental ingestion of fish bone are common. But ingestion of fish bone rarely causes perforation of the gastrointestinal tract or an intra-abdominal abscess. We report herein a case of a 78-year-old man with a periumbilical mesenteric abscess caused by fish bone which was ingested unconsciously. The fish bone was found in the terminal ileum and it was removed by colonoscopy. The patient improved and he was discharged after systemic antibiotic therapy. Occasionally, when patients swallow fish bone without a foreign body sensation, clinicians should suspect perforation caused by fish bone in case of an intra-abdominal abscess of unknown cause.
Abdominal Abscess ; Abscess ; Aged ; Colonoscopy ; Eating ; Foreign Bodies ; Gastrointestinal Tract ; Humans ; Ileum ; Mediastinitis ; Neck ; Sensation

We experienced a case of 1 patient who died from rhabdomyolysis-related complications after colonoscopy. A 60-year-old man had undergone an ‘uncomplicated’ colonoscopic polypectomy. Approximately 10 hours following this procedure, the patient complained of increasing left abdominal pain. His computed tomography image showed free gas, but his operative findings revealed no macroscopic perforation or abscess formation. Eight hours after the operation, the patient presented with myoglobulinuria, and we diagnosed the condition to be rhabdomyolysis. Based on this case, we recommend that rhabdomyolysis be added to the list of complications following a colonoscopic procedure. Moreover, for prevention and early treatment, endoscopists should be attentive to the risk factors and signs/symptoms of rhabdomyolysis.
Abdominal Pain ; Abscess ; Colonoscopy ; Humans ; Middle Aged ; Rhabdomyolysis ; Risk Factors

PURPOSE: To clarify the clinical features of appendicitis in preschool children and to explore clinical appendicitis scoring systems in this age group. METHODS: We retrospectively collected data on 142 children, aged 10 years or younger, with confirmed diagnosis of appendicitis based on surgical and pathologic findings. Enrolled subjects were divided into two groups: Group 1 (preschool children aged ≤5 years, n=41) and Group 2 (school children aged >5 to ≤10 years, n=101). Data analyzed included clinical presentation, laboratory findings, the pediatric appendicitis score (PAS), and the modified Alvarado score (MAS). RESULTS: The most common presenting symptom was abdominal pain in both groups (92.7% vs. 97.0%). Other presenting symptoms were as follows: fever (65.9%), vomiting (68.3%), right lower quadrant (RLQ) localization (24.4%), anorexia (14.6%), and diarrhea (7.3%) in Group 1, and RLQ localization (74.3%), vomiting (71.3%), anorexia (52.5%), fever (47.5%), and diarrhea (11.9%) in Group 2. Perforation and abscess occurred more frequently in Group 1 than in Group 2 (43.9% vs. 12.9%, p < 0.001; 34.1% vs. 5.0%, p < 0.001; respectively). PAS and MAS were lower in Group 1 than in Group 2 (4.09±1.97 vs. 6.91±1.61, p=0.048; 4.65±1.79 vs. 6.51±1.39, p=0.012; respectively). CONCLUSION: In preschool children, appendicitis often presents with atypical features, more rapid progression, and higher incidence of complications. This age group is more likely to have lower PAS and MAS than those of school children.
Abdominal Pain ; Abscess ; Anorexia ; Appendicitis ; Child ; Child, Preschool ; Diagnosis ; Diarrhea ; Fever ; Humans ; Incidence ; Retrospective Studies ; Vomiting